0001209191-18-038596.txt : 20180619 0001209191-18-038596.hdr.sgml : 20180619 20180619164814 ACCESSION NUMBER: 0001209191-18-038596 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180619 FILED AS OF DATE: 20180619 DATE AS OF CHANGE: 20180619 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: OCLASSEN GLENN A CENTRAL INDEX KEY: 0001210529 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38529 FILM NUMBER: 18907684 MAIL ADDRESS: STREET 1: 3290 WEST BAYSHORE RD CITY: PALO ALTO STATE: CA ZIP: 94303 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Verrica Pharmaceuticals Inc. CENTRAL INDEX KEY: 0001660334 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 463137900 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 200 GARRETT STREET CITY: CHARLOTTESVILLE STATE: VA ZIP: 22902 BUSINESS PHONE: 434-980-8100 MAIL ADDRESS: STREET 1: 200 GARRETT STREET CITY: CHARLOTTESVILLE STATE: VA ZIP: 22902 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2018-06-19 0 0001660334 Verrica Pharmaceuticals Inc. VRCA 0001210529 OCLASSEN GLENN A C/O VERRICA PHARMACEUTICALS INC. 10 NORTH HIGH STREET, SUITE 200 WEST CHESTER PA 22902 1 0 0 0 Common Stock 2018-06-19 4 C 0 200734 A 290421 I See Footnote Series A Convertible Preferred Stock 2018-06-19 4 C 0 200734 0.00 D Common Stock 200734 0 I See Footnote Each share of Series A Convertible Preferred Stock was convertible at any time at the option of the holder into Common Stock, had no expiration date and converted into shares of Common Stock upon the closing of the Issuer's initial public offering. The shares are held directly by The Glenn A. Oclassen 2016 Trust dated November 30, 2016 (the "Trust"). The Reporting Person serves as trustee of the Trust. /s/ Edward Sniezek, Attorney-in-Fact 2018-06-19